Methods of research of the pancreas

Diseases of the pancreas are far more frequent than they are diagnosed. The most commonly misspelled in the diagnosis of chronic and especially functional lesions of the body. The thing is that although the history and methods of routine clinical examination, undoubtedly, are essential and often allow to suspect the disease of the pancreas, they, however, does not always solve the issue of the final diagnosis.
Deep location of an organ in the abdomen makes it inaccessible physical methods of research; among them the most value belongs to palpation. Using the method B. N. Obraztsov, in a healthy person, the pancreas is unable to probe in exceptional cases, when the weak development of muscles of the anterior abdominal wall. When zooming in, and the seal of the body of this method gets practical value.
In inflammatory processes in the pancreas by palpation can discover local tenderness, with the defeat of the head it is revealed in the area of soffera-Rive (zona pancreatico-choledochica, Fig. 66), and with the defeat of the tail cancer - in left hypochondrium on line connecting the navel from the middle of the left costal arch (point Mayo-Robson).

Fig. 66. Area Of Soffera - Riva. Explanation in the text.

Particular value because of the ease techniques have pain palpation proposed by the Polish Clinician Grott (1935). Palpation on Grott is performed with the patient lying on his back and on the right side. In both cases, the principle palpation is touching the body of the pancreas by crushing it to the left side of the spine in place of intersection with his body. To this end, the fingers of the right hand of the researcher are placed parallel to the outer edge of the left rectus, the latter moves to the middle line, and palpation is made abroad. The patient gives the position most comfortable for holding palpation. With the patient lying on his back legs should be bent at the knees, and one or both hands patient with clenched fists planted under the loin. Palpation is bimanual so that the fingers of the right hand are for the perception of feelings by touching, and placed on them, the fingers of his left hand, putting pressure contribute to penetrate deep into the abdominal cavity. Palpation in position on the right side of the patient bend your knees slightly rejects the trunk ago. The doctor comes front and alpinum right hand and the other fixes the side surface of the left side of the chest of the patient. In both cases, the patient must breathe calm down and get over voltage abdominal muscles and the doctor to use moments of deep exhalation of the patient, to further penetrate fingers into the abdominal cavity and to achieve the pancreas. Then the patient offer 2-3 times to take a deep breath and hold your breath after a quick deep exhalation. This point is used to palpation gland, pressing her to the spine.
Palpation healthy pancreas painless, and
in pathological process in the body it is accompanied by pain, especially in acute pancreatitis, and the exacerbation of chronic pancreatitis. Proposed Grott (1946) palpation in the position of the patient standing and sitting allows you to probe the tail cancer. It is bimanual. The right hand penetrate in the left hypochondrium and body pressed to the fingers of the left hand to the left in the lumbar region (Fig. 67, 68).

Fig. 67. Bimanual palpation of the pancreas in a supine (Grott).
Fig. 68. Palpation of the pancreas in position on the right side (on Grott).

Grott and Grott-Swiezawska (1970) found indications of pain palpation in individuals undergoing surgery or require surgery for chronic pancreatitis.
In chronic diseases of the pancreas Grott often found asymmetry in the thickness of the subcutaneous tissue. In these cases taken fingers skin fold on the left and slightly higher from the navel thinner than the right.
Mallet-Gny (1943), using the principle of pain palpation order to bypass the stomach, located between the pancreas and the anterior abdominal wall, recommends palpation in the patient on the right side with the torso forward up to 45 with half-bent legs. The right hand fix the trunk of the patient, and the outstretched fingers of his left hand penetrate deeper in region IX rib under the diaphragm and press deep into the abdominal cavity to the side of the spine. Mallet-Guy believes that this stomach down one's pressing away and forth outside of the investigated area.
Despite significant practical value, methods of pain palpation are not specific for diagnosing diseases of the pancreas, because the pain can often be caused by damage to the adjacent organs.
Some diagnostic value has detection of diseases of the pancreas zone hyperalgesia in the area of the 8-th of spinal segment on the left.
Independent pain in the upper abdomen, radiating to the left, should always call a doctor suspicion of a possible disease of the pancreas.